A Ten-Year Follow-Up Study of the Association Between Uric Acid and Adverse Cardiovascular Events in Patients With Coronary Artery Disease

Abstract

The association between uric acid (UA) and long-term mortality in patients with coronary artery disease (CAD) is poorly investigated. We assessed the association between UA and 10-year mortality after percutaneous coronary intervention (PCI) in 3998 patients undergoing PCI. Patients were categorized in groups according to UA tertiles: tertile 1 (UA<5.80 mg/dl; n=1347), tertile 2 (UA, 5.80 to 7.04 mg/dl; n=1340) and tertile 3 (UA>7.94 mg/dl; n=1311). The primary outcome was 10-year all-cause mortality. All-cause deaths occurred in 1200 patients: 320 deaths (26.5%) in patients with UA in the first tertile, 325 deaths (26.9%) in patients with UA in the second tertile and 555 deaths (46.0%) in patients with UA in the third tertile (adjusted hazard ratio [HR]=1.22, 95% confidence interval [CI] 1.17-1.27, P<0.001), for 1 mg/dl increment in the UA level. Cardiac deaths occurred in 748 patients: 194 deaths (16.5%) in patients with UA in the first tertile, 202 deaths (17.0%) in patients with UA in the second tertile and 352 deaths (29.7%) in patients with UA in the third tertile (adjusted HR=1.24 [1.17-1.32], P<0.001, for 1 mg/dl increment in the UA level). The 10-year rates of target lesion revascularization, target vessel revascularization or nontarget vessel revascularization did not differ significantly according to the UA level. In conclusion, in patients with CAD treated with PCI, elevated UA level was associated with higher 10-year mortality. Elevated UA level was not associated with progression of atherosclerosis in nontreated coronary vessels or progression of intimal hyperplasia in stented lesions requiring intervention.